Provider Demographics
NPI:1104134469
Name:SOUTHERN MEDICAL TRANSPORT
Entity type:Organization
Organization Name:SOUTHERN MEDICAL TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:SAVAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-206-1176
Mailing Address - Street 1:PO BOX 940
Mailing Address - Street 2:
Mailing Address - City:COLBERT
Mailing Address - State:GA
Mailing Address - Zip Code:30628-0940
Mailing Address - Country:US
Mailing Address - Phone:706-206-1176
Mailing Address - Fax:706-788-0058
Practice Address - Street 1:276 KINCAID CEMETERY RD
Practice Address - Street 2:
Practice Address - City:COLBERT
Practice Address - State:GA
Practice Address - Zip Code:30628-2547
Practice Address - Country:US
Practice Address - Phone:706-206-1176
Practice Address - Fax:706-788-0058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10048979343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)